MEDICARE: MRS. DIANE MORRIS REICH MS, CNC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133NN1002X	Nutrition Education Nutritionist

General Provider Information

NPI Number	:	1912236647
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DIANE MORRIS REICH MS, CNC

Provider Business Mailing Address
First Line	:	10260 SW GREENBURG RD
Second Line	:	SUITE 400
City	:	PORTLAND
State	:	OR
Zip	:	97223-5500
Country	:	US
Telephone Number	:	503-341-1075
Fax Number	:	503-293-8499

Provider Business Practice Location Address
First Line	:	10260 SW GREENBURG RD
Second Line	:	SUITE 400
City	:	PORTLAND
State	:	OR
Zip	:	97223-5500
Country	:	US
Telephone Number	:	503-341-1075
Fax Number	:	503-293-8499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/08/2009
Last Update Date	:	12/08/2009

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